What is Exercise-Induced Bronchoconstriction?

Exercise-induced bronchoconstriction is caused by the narrowing of the small bronchial tubes in the lungs. Children exercising or playing sports tend to breathe quickly, shallowly, and through the mouth. This prevents warming and humidifying the air before it reaches the lungs. Cold, dry air causes the airways in the lungs to narrow, blocking air and making it difficult to breathe.

Asthma is the most common chronic medical problem in children. The most common symptoms are wheezing, difficulty breathing, chest tightness, and chest pain. Asthma symptoms can be triggered by allergies, exposure to cigarette smoke, a cold, or exercise. A child that only has symptoms of asthma with exercise may have exercise-induced bronchoconstriction (EIB). It is also possible to have both underlying asthma and EIB. Exercise-induced bronchoconstriction is more common in children if they have a diagnosis of asthma, allergies or eczema.

How do I know if my child has ­­­­­­­­­­exercise-induced bronchoconstriction?

Children with exercise-induced bronchoconstriction often begin having symptoms five to 10 minutes after starting to exercise. Symptoms generally peak five to 10 minutes after stopping the activity, and may take an hour or longer to end.

Symptoms of exercise-induced bronchoconstriction include:

• Wheezing
• Shortness of breath that lasts for a while
• Tightness or pain in the chest
• Coughing

Other signs of ­­­­­­­someone who may have exercise-induced bronchoconstriction include:

• Gets winded or tired easily during or after exercise
• Coughs after coming inside from being active outdoors
• Can’t run for more than a few minutes without stopping

How is exercise-induced bronchoconstriction diagnosed?

A doctor will take a detailed history, asking questions about your family history of asthma and allergies. They will also ask questions about the symptoms and triggers your child has been having.

Your child’s doctor will complete a physical exam to test the function of your child’s lungs.

Spirometry Test

A spirometry test is used to assess how well the lungs function when your child is at rest. The spirometer measures how much air they inhale and exhale, and how quickly they exhale. Your child’s doctor may also give an inhaled medication to open the lungs and repeat the test to determine whether the medication improved your child’s airflow.

Exercise Challenge Tests

Your child’s doctor may ask them to run outside or on a treadmill in the office for up to 10 minutes to increase your child’s breathing rate. The spirometry test will be completed before and after this challenge.

How is exercise-induced bronchoconstriction treated?

Once your child’s diagnosis is made, their doctor will determine the best possible treatment plan. Medications may be prescribed.

Pre-Exercise Medications

These are taken before exercise to prevent or minimize any exercise-induced bronchoconstriction. Your child’s doctor will discuss how much time is needed between taking the medication and exercising. These types of medications include:

• Short-acting beta agonists (SABAs) – the most common inhaled medication to help open airways, such as albuterol.
• Ipratropium – inhaled medication, taken with a nebulizer, which relaxes the airway.

Long-Term Control Medications

These are taken to manage underlying chronic asthma or to help manage symptoms when pre-exercise medications are not effective alone. These medications are usually taken daily and may include:

• Inhaled corticosteroids – Helps suppress inflammation in the airways. The most benefit occurs after two to four weeks.
• Combination inhalers – Helps relax the airway.
• Leukotriene modifiers – A medication taken by mouth to block any inflammation in the airway. Talk to your doctor about any potential side effects.

How can exercise-induced bronchoconstriction be prevented?

• Complete a warm-up with varying intensities before beginning regular exercise.
• Breathe through your nose to warm and humidify the air before it enters the lungs.
• Use proper clothing, such as a scarf or facemask, when exercising in cold, dry weather.
• Avoid allergy triggers.
• Avoid strenuous exercise if your child has a cold or respiratory infection.
• Exercise regularly.
• Make sure your child has step-by-step instructions for teachers and coaches that explain what to do for your child during an asthma attack.

Exercise-induced bronchoconstriction prognosis

For most children with EIB, proper diagnosis, treatment and prevention measures will allow your child to continue to remain active.

Call your child’s doctor if:

• Your child is experiencing any signs or symptoms of exercise-induced bronchoconstriction.
• Your child is having any shortness of breath or wheezing that is quickly getting worse.
• No improvement is seen in your child’s condition after using their prescription inhaler.